MEDICARE: ANGELUS ALH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1295467439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELUS ALH LLC

Provider Business Mailing Address
First Line	:	2220 PAXSON DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-3412
Country	:	US
Telephone Number	:	571-243-5486
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 PAXSON DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-3412
Country	:	US
Telephone Number	:	571-243-5486
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARJORIE CRUZ
Credential	:	RN
Telephone Number	:	571-243-5486

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/29/2022

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Directions to “ANGELUS ALH LLC ” Practice Location

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